Inferno

by Steven Hatch, M. D.

  As it became clear that Christie was at a high risk of being perceived by the voting public as a crass bully—which is what he really is—the administration quickly pivoted, and less than seventy-two hours after the start of the brouhaha, Hickox was granted leave to become someone else’s problem and was allowed to catch a jet to Maine. There she would find an entirely new circus to contend with and a conflict with a governor far less predisposed to care about the opinions of voters in Iowa, or for that matter even of the voters in Maine: Paul LePage.

  But those three days, from our vantage point in Liberia, had already done substantial damage to what we saw as the necessary work to bring the outbreak to heel. We were all going to need replacements, and the Americans were leading the call. It wasn’t merely an impulse toward tree-hugging humanitarianism that provided a sound rationale for doctors and nurses and sanitation engineers to come over; it was a desire to prevent a biomedical disaster in the United States. If the wealthy countries turned their backs on West Africa, there was an excellent chance the epidemic would spread unchecked and the virus would start to run over borders into Senegal, Mali, Ivory Coast, and beyond.

  The more the disease was feared and stigmatized, the more likely that people with means to do so would flee, which in turn meant the more likely the virus was to spread. Moreover, potentially infected people would minimize their symptoms and lie about them to authorities. The more punitive the policies, the better the chance would be that the virus, driven underground, might pop up in unexpected places. And finally, if those very policies did lead to the spread of the virus back to other countries in West Africa such as Nigeria, the northern hub of all sub-Saharan African travel that had just contained its own outbreak, it could lead to a shutdown of any international travel through Africa, turning what was already a multibillion-dollar problem into a multitrillion-dollar problem.

  So with Christie and LePage and Jindal all instituting draconian policies designed to punish the very people who were most willing to risk the danger of coming to help, we all fretted that the volunteer well would dry up. All of the aid organizations rallied and did a media blitz to try to counter the fear that was now running rampant in the United States. IMC asked me to do a spot on Good Morning America just before we knew that Hickox would be allowed to leave New Jersey. I didn’t like the idea of doing a television interview—you might be under the impression by this point that I don’t care much for TV news—especially on a fluffy show like GMA that provides a product that can be only generously described as “news,” geared as it is to avoid the complexities of a story. And the Ebola story had become quite complex by that point. At first I balked, but it was made clear that IMC considered this a priority not merely for itself but as part of a unified response by the aid organizations in defense of public health, and so I agreed to the interview. What I feared was that GMA, in a quest for simple and undemanding story lines, would try to enlist me in turning this into a referendum on Chris Christie. I suspected that I’d be baited into talking trash.

  This proved true almost the moment the interview started. It was about 4:30 a.m. in New York when I got onto Skype to talk to one of the show’s producers, as the interview was being recorded for later viewing. I was first asked what I thought of Christie’s policy. Without mentioning Christie by name, I replied that if we discouraged volunteers from coming to Africa, we might make the problem worse and that might have unintended consequences. But Christie is taking a policy stand like this because people in the States were scared—was I saying that people were foolish to be scared? No, I was saying that we need to consider the optimal way to try to contain this outbreak, and that involves fighting it at its source. So, wait, came the reply, was I saying that I knew more about public policy than the governor of a large state who is running for the presidency of the United States? Well, no sir, that’s not what I said. And gotcha questions like this continued on for several more minutes.

  Then came some personal questions. “So when will you be coming home?” he asked.

  “Soon,” I replied.

  “How soon?”

  Was he really asking me, just days after I had watched Craig Spencer’s every movement since he had come home tracked to within a millimeter, with Kaci Hickox still lingering in a makeshift tent in a parking lot in New Jersey, to divulge my travel plans in front of five million people? “Soon,” was my sing-songy response as if he had asked me about how the weather was here in Liberia. I desperately hoped the answer managed not to sound testy to viewers, while simultaneously sending a clear message to this guy to back the hell off.

  And on it went. Each question felt like a little electronic noose was being thrown over my head, and each time I wiggled out of it, not giving the producer that sound bite he seemed to covet in which I made some crack about what an ass Christie had been or how hysterical the American people had become over Ebola. I considered both of those sentiments perfectly true, but the last thing that we needed in the public dialogue was more shouting and needless distraction.

  The message wasn’t complicated: We need people over here. Treat people like Kaci Hickox poorly, and we won’t get people over here. Run away from the problem here, and God only knows where this thing goes. But none of my pronouncements was juicy enough, and after about ten minutes of this cat-and-mouse game, I could sense the producer in New York had lost interest. “Do you have any last thoughts?” he offered.

  “Actually, I do,” I said. “You need to understand that I’ve been working here in Liberia for the past four weeks, right here with the virus, every single day. I think it’s ironic that I’m actually much more anxious about going back to the United States than I am about working here in an Ebola Treatment Unit, in a country where the epidemic is still out of control.”1

  That was the only line that made it to the report, and it appeared during a montage of Ebola B-footage showing the usual scenes of people milling about in protective gear, with no context for where that statement came from and no explanation that it was even an interview conducted by GMA’s producers or the question to which I was responding. I didn’t see the piece until weeks after I had arrived home, and when I watched it, I felt like I was looking at a Dada art exhibit.

  But as I finished the interview and returned to work, I realized it was true: Liberia was going to be a much safer, or at least less anxiety-provoking, place than what awaited me. And because of the events that had just taken place with Spencer and Hickox, I had about twelve days to figure out my game plan.

  When I first came over, I hadn’t given much thought to what life would be like upon return. First, I wasn’t all that concerned, because I figured there was a more than reasonable chance I wasn’t coming home anyway. Second, I had what I now realize was an overly simplistic view of how the federal and state governments would treat returning volunteers. This was, after all, a world health crisis, the likes of which hadn’t ever really been seen before. You could make all sorts of historical comparisons to various pandemics—SARS in 2003, the Great Influenza of 1918, the Black Death—as an exercise in compare-and-contrast to highlight just how different this was.

  Surely, I thought, our enlightened leaders will figure out a way of quarantining us in a place where we can have relative freedom and pose no threat to the populace. There was much talk about this at our training course in Alabama. I am now embarrassed to say that I actually thought there was a real chance that, assuming I hadn’t been chopped to little Stevie-pieces by a terrified and enraged Liberian populace or melted into an Ebola goo by a microscopic virus, I would find myself riding out November at a U.S. Army base canteen on some far-flung island like Diego Garcia with fellow volunteers and writing about the experience on my laptop. (Diego Garcia is a Navy rather than Army base, but whatever.)

  To say this was hopelessly naïve on a variety of levels is to understate the case. The confusion caused by a situation that was shifting by the hour, the fact that all our political leaders were under intense scrutiny, augmented
by the unfortunate coincidence of a midterm congressional election and the stirrings of a Republican presidential primary, to say nothing of the labyrinthine complexities of governmental bureaucracies, and no clear indicator of which sectors of government would be responsible for suggesting or instituting such a plan, meant that there was no way there would be some kind of decent civilian-return policy anytime soon. But I didn’t work in government, and so a part of me thought that we might all be taken care of by a few strokes of a pen of some well-meaning public official, like a governor or, oh, say, a president of the United States. That notion was in for a big splash of cold water.

  To get a sense of what I might expect, a few days before the Craig Spencer story broke I asked some colleagues back at UMass who might be a good person to contact about this. I was eventually given the name of someone who worked at the Massachusetts Department of Public Health, and I shot off an e-mail asking what the policy would be for me upon my return. Although I wasn’t even remotely the first person to be returning to Massachusetts from one of the affected countries, or even the first health-care worker in an Ebola Treatment Unit, I might well be the first one to return after Craig Spencer had developed Ebola.

  So I had more than a few questions: Was I going to be subject to the kinds of unsavory restrictions that had been cooked up in New Jersey and Maine? Would any housing be provided for me? Would I be allowed to return to work? The last question was of particular importance because I had no vacation time left; I had entirely used up my fiscal 2015 allotment during October—yes, my time in Liberia was considered a vacation by the hospital administration, a long story we don’t have time for in this book—and would cease to draw a paycheck even before I got back. Another twenty-one days out of commission was going to be a major financial blow.

  I didn’t hear anything from the DPH contact for another few days, then Craig Spencer came down with Ebola, and I sent another more urgent e-mail asking whether any policy was in effect.

  “We’re working on it,” was the terse reply that came.

  With not much more than a week to go, I had to make some choices. Every option came with risks, and the risks in turn dealt with how my return would be perceived by people back in Massachusetts.

  The first and most obvious option was to simply return to my home. But I had two children in seventh grade, each in a different school. I figured that most parents would be split into about three different groups, each with a distinct reaction to my presence. The majority of them wouldn’t really care or think it an especially big deal in terms of their families’ risk. A sliver of parents would think that this was a really cool thing and it would be a teachable moment for their kids.

  It was, however, the third group about whom I was most concerned: the paranoid parents who would think that by cohabitating with my children after my journey, I was potentially putting their children at risk of catching Ebola by sending my potentially infected kids to school. Every school has a mother or father like this.2 I knew that there wouldn’t be many such parents, but I also knew that all it would take was one determined mother or father to make a potentially huge issue out of this, and I worried that my children might be shunned by classmates out of fear and that the entire situation would place the school administration in an uncomfortable position. Indeed, I had already needed to fire a warning shot to the schools when, looking at the schedule, my wife, Miriam, and I realized that my daughter’s parent-teacher conference had been scheduled for mid-November, when I would still be in the midst of my twenty-one-day waiting period. We sent an e-mail to the school leadership and said we should reschedule.

  The reply was heartwarming: No, Steven, we think what you’ve been doing is remarkable and we want to show our support. We’ll practically parade you around to show how special this is. I wrote them back and said that while I was touched, they needed to consider what this might do to their recruitment efforts for the following year if the news got out about how cavalier they were with the safety of the children by allowing a biological threat to wander about the school. That got their attention, and we rescheduled.

  School issues were only the beginning of my concerns when I went back home. How would my neighbors perceive me? What would happen if a local TV station—let’s say, one belonging to a network that might be known at a national level for doing journalism based in part on fearmongering—decided to show up outside my door one day to report that the Ebola doctor had plotzed himself down right in the middle of one of the more idyllic suburbs of Boston?

  And what would happen if I did develop symptoms? That was, of course, a real possibility. My house would turn to bleach as scores of workers in hazmat suits sterilized every surface of my living space. Our furniture, paintings, and other objects would be ruined. Coupled with the school problems and the potential media circus, the loss of family heirlooms seemed to put the nail in that coffin. Going home was definitely not Option #1.

  Finding somewhere else to go presented similar problems. At first we had a promising lead from a friend of a friend who owned a getaway cabin in the woods in central Massachusetts. It seemed too good to be true: I’d be away from people but still close enough that I could commute to Worcester. It turned out that it was too good to be true. As the Spencer/Hickox story grew, we received word that the people who made the offer suddenly realized—oops!—that they had rented the cabin to someone else during that period. Their excuse seemed fishy, but there wasn’t much point in expressing disappointment. And so it was back to the drawing board.

  Staying at a hotel posed a host of public relations issues: What would happen if one of the guests or staff found out who I was? Would they kick me out? And what if that TV news crew I was worried about showed up here? This time I would be outside stuffing my belongings into my car after I had been tossed out by the management. I considered the small minority of people who were in a frenzy about Ebola, and thought that it takes only one nut with a gun and an overdeveloped sense of vengeance for me to end up in a pool of blood in a parking lot.

  The hardest part was that I was trying to make decisions based on two variables: how my actions would be viewed in retrospect if I became a public figure and what would happen if I did actually become sick with Ebola. Maybe it was paranoia, but watching what had happened to Craig Spencer, I thought that some contingency planning was in order. And I had no idea what new events would unfold over the next several days as I made plans.

  With less than a week to go, I still had heard nothing about what the state would require of me, and so I sent a follow-up e-mail, which was met with the same short, and not especially friendly, reply. Whatever was going to happen, the Commonwealth of Massachusetts was effectively saying to me that I was on my own. I therefore made the decision to reserve a room at a hotel in the vicinity of Worcester. I’d get in from the airport, find a local hotel and crash, get up the next morning and pick up my stuff from the house once the kids had cleared out, as I didn’t want anyone to think I’d be so cavalier as to have physical contact with them, and drive toward Worcester to set up temporary shop for twenty-one days.

  *

  Which brings me back to my ride into Monrovia that Thursday, as I was to spend one night in the capital before making my way back home. I had been couriered into town by the IMC driver over a five-hour drive, during which most of the time I sat quietly, pondering how I arrived at that precise moment, not quite believing I was still alive, with no real plan for how to cope with the waves of emotion that were now crashing at the shores of my consciousness. Even in my most subdued moments, I am an extremely emotionally intense person, so much so that many people find me either off-putting or intimidating or both. And the turbulence my soul was experiencing on that car ride, and for some time to come, was especially intense. To say it would have some repercussions in my personal life is to understate the case. So I used the drive to try to map out a mental plan of what the next several days would look like, slowly becoming aware as we approached Monrovia’s outskirts th
at there was this huge surge of humanity whose central preoccupation wasn’t a ramshackle set of tarps in a split of jungle more than a hundred miles to the north. I had either traveled several hours, or several light-years, depending on how you measured these journeys.

  The IMC apartments were in a compound in the Congo Town neighborhood, about a half hour’s walk east on Tubman Boulevard from JFK Hospital, and we got there in midafternoon. Having seen them for only a few minutes when I had first arrived about five weeks before, I had forgotten how nice the accommodations were: The floor was a polished stone, with comfortable couches in a large living room and a wide-screen television mounted on the wall. Tubman’s bustling traffic could be heard outside. I sat for a few minutes in stunned silence as I soaked in a world that seemed to be going about its business, blithely unaware that apocalyptic events were still transpiring throughout the countryside, and indeed in the city limits. The normality of life felt like an electric shock.

  That evening I had dinner with Sheri Fink, who was still working in Monrovia. We ate at a seafood restaurant called Anglers not far from the central government buildings. Anglers was popular among the expat crowd; it was located on the beach, so that if you got there early enough you were treated to a beautiful sunset scene over the Atlantic. We sat on the outside deck eating delicious food, a luxury that seemed obscene to both of us. And for the third time that day, I wept uncontrollably, with Sheri having to suspend her work for The New York Times to take on the temporary role of crisis psychotherapist.

  The next day, hours before my departure, I walked over to the IMC headquarters to debrief with Sean. Like the rest of Monrovia, the IMC offices provided a scene of a city on the move, with easily a dozen people, a mix of expats and Liberian staff, all engaged in the humdrum work of accomplishing administrative tasks. I was being ushered back into a world not only with a different pace but a lower temperature, lacking the fevered sense of dour purpose that was the ETU’s essence. It was the beginning of a series of jolts that would last for the next few weeks as I gradually, and not altogether successfully, returned to my previous life.